In Nebraska, an Unlikely Alliance Fights for Prenatal Care for Undocumented Women

April 18, 2012

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Nebraska’s state legislature, one of the more inventive when it comes to finding ways to restrict access to reproductive healthcare, is poised to override Governor Dave Heineman’s veto of a bill that would extend prenatal care to undocumented immigrants. Heineman, who is strenuously anti-choice, is apparently equally strenuously anti-immigrant. But other Republicans and anti-choicers in the state evidently are not: the legislation is endorsed by the Republican speaker of the legislature, Mike Flood, who has sponsored legislation to ban late-term abortions, as well as a number of other anti-choice lawmakers, and by Nebraska Right to Life and the Nebraska Catholic Conference.

The bill would restore coverage for prenatal services to pregnant women who are ineligible for Medicaid for reasons other than income (those are largely undocumented women, though not solely). Nebraska provided that care until two years ago, when the federal government said it could no longer use Medicaid funds to do so. The state could have preserved funding simply by switching its funding stream to SCHIP, but declined to do so. Sixteen other states provide such coverage to undocumented women, but no neighboring states do; Governor Heineman claims that the legislation would turn Nebraska into a “a magnet for illegal aliens.”

If the bill has made enemies of friends, it has also made for allies of usual opponents, including Right to Life and the pro-immigration reform, pro-universal health care group Nebraska Appleseed Center for Law in the Public Interest. Jennifer Carter, director of public policy at the Appleseed Center, told me “This is first time we’ve had a common focus that I can recall” but “there’s been a lot of common ground on it from the perspective of protecting the health of unborn children. it’s foundational: you have to start with good prenatal care.” The local Planned Parenthood affiliate, Planned Parenthood of the Heartland, supports the bill and has mobilized “friendly senators and our supporters” but has mostly stayed out of the coalition’s way. “Particularly in Nebraska, there is some politics that enters in whenever Planned Parenthood shows up. In this instance, we don’t want politics to get intermixed with what’s right for a women and her healthcare,” says Kyle Carlson, director of legal and public policy at Planned Parenthood of the Heartland.

The coverage provided is limited to healthcare services that affect the health of the fetus; in some cases, even postpartum care for the woman is not covered. As the Appleseed Center’s fact sheet states, “The unborn child, rather than the pregnant woman, is the recipient of CHIP-funded services.” Does it matter that the state is adopting federal policy that says that prenatal coverage is specifically for “unborn children,” not women? “We generally find that troubling, because we focus on women and on healthy pregnancies, and we try not to separate those two,” Carlson says. “We try not to get too hung up on that, but that’s not how we would word it.”

When I asked Carter whether the law might expand rights for fetuses at the expense of women, she answered, “The only thing that this law does is adopt what is already in federal law. It wouldn’t technically expand anything.”

Meanwhile, Nebraska remains a deeply inhospitable state for women, whether citizens or not, to access reproductive healthcare. Graded “F” by NARAL Pro-Choice America, Nebraska has biased counseling and mandatory delay laws on the books, doesn’t permit the use of Medicaid funds for abortion care and has in recent sessions considered both a bill to amp up counseling requirements mandating that doctors suggest to patients that they’re taking the risk harming their mental health by having an abortion, and a direct challenge to Roe that would ban abortions after twenty weeks without providing an exception for the health of the woman.

While this bill is laudable for expanding healthcare services, Nebraska’s antipathy to healthcare for pregnant women means “we have been forced into a position of fighting to fund piecemeal what is anything but the full and holistic needs of every woman,” says Lynn Paltrow, executive director of National Advocates for Pregnant Women.

Today is the last day the Nebraska state legislature is in session, so the bill will override Heineman’s veto or die today. I’ll keep you updated!

Update, April 20th, 11:10am: I got another perspective from Kimberly Inez McGuire, policy analyst at the National Latina Institute for Reproductive Health, who told me, "It’s a good policy with a bad justification. On the one hand, we know that undocumented women face so many barriers to getting healthcare, so the fact that this policy would extend care to them is a good thing. But the way that it’s done, with this language that unnaturally separates health of fetus from health of the mother, is dehumanizing to women. The health of the woman is inextricably linked to the health of her child. This sets a dangerous precedent that we’ll be watching closely."